硬膜外吗啡与吗啡氯胺酮术后病人自控镇痛

Comparison of epidural morphine and morphine combined with ketaming inpostoperative patient contralled anaigesia

目的 ;探讨手术后应用吗啡与吗啡复合氯胺酮行PCEA的效果以及氯胺酮对吗啡镇痛作用和不良反应的影响。方法 ;40例ASA1～2级择期在腰麻复合硬膜外麻醉下行妇科手术的患者 ,随机分为单纯吗啡(M)和吗啡复合氯胺酮(KM)两组 ,每组20例 ,术后连接GRASEBY9300型PCA泵 ,镇痛药液中M组含吗啡20mg,KM组含吗啡10mg+氯胺酮100mg。分别于术后4、8、12、24h进行随访 ,记录病人首次按压时间、各时间点视觉摸拟评分(VAS)、有效按压次数、不良反应及病人综合满意度。结果 ;两组患者术后首次按压时间、有效按压次数无显著性差异。吗啡用量M组明显高于KM组(P<0.05)。所有患者4、8、12、24h各时间点VAS评分均低于4分 ,且组间比较无显著性差异。M组患者恶心、呕吐发生率显著高于KM组(P<0.05)。两组均未发现有皮肤搔痒。另外两组患者对镇痛效果综合满意度评估优良率为100 %。结论 ;氯胺酮可以增强吗啡的镇痛作用 ,减少吗啡用量 ,降低吗啡不良反应发生率。

Objective: To discuss the effect of epidural morphine and morphine combined with ketamine in PECA, and of ketamine effects on analgesia and side effects of morphine. Methods: 40 patients ASA grade 1～2, under subarachnoid combined with epidural anaesthesia for selective gynaecological surgery were randomly assigned into two groups, morphine group (M) and morphine/ketamine group (KM). At the end of operation, a GRASEBY9300 PCA was connected to the epidural catheter. Analgesic solution contained morphine 20mg in group M and morphine 10mg +ketamine 100mg in group KM. The patients were followed up at 4, 8, 12, 24h after operation and first pressing time, VAS, effective pressing numbers, side effects and patients general satisfactory degree were recorded. Results: First pressing time and effective pressing numbers showed no significantly difference between two groups. The dosage of morphine significantly higher in the group M than that in the group KM (P<0.05). VAS ratings at 4, 8, 12, 24h were all bellow 4, There were no significant difference between two groups. The incidence of nausea and vomiting in the group M was significantly higher than in the group KM (P<0.05). No itching was complained in two groups. Conclusion: Ketamine can improve the analgesic effect of morphine, so that decrease the dosage of morphine and the incidence of its side effects.